Parapneumonic Effusions and Chest Tube Insertion

Abstract

To the Editor: We reviewed the frequency of therapeutic and diagnostic thoracentesis in 16 patients with complicated parapneumonic effusion treated initially with antibiotics alone. Twelve of the 16 patients underwent a single therapeutic thoracentesis during hospitalization; all 12 were performed during the initial evaluation. Of the 12 patients, five underwent follow-up diagnostic thoracentesis (2 to 10 ml) to document improved pleural fluid characteristics. There was one death in this group. The complicated parapneumonic effusions resolved without repeated therapeutic thoracentesis in the remaining 11 patients. Four of the 16 patients with complicated parapneumonic effusions treated initially with antibiotics alone underwent repeat therapeutic thoracentesis. Of these four patients, two eventually required chest tube drainage because of persistent fever, leukocytosis, and persistently positive fluid cultures. Therefore, our study does not demonstrate that repeated therapeutic thoracenteses were responsible for the successful resolution of the complicated parapneumonic effusions in the patients treated only with antibiotics. However, due to the small number of patients in our study, insufficient data are available to clearly determine whether the clinical course of complicated parapneumonic effusions is altered with single vs repeat therapeutic thoracentesis. A prospective trial with therapeutic groups (including a single therapeutic thoracentesis, repeated therapeutic thoracenteses, and immediate chest tube drainage) is required to determine the optimal management of patients with complicated parapneumonic effusions. Parapneumonic Effusions and Chest Tube InsertionCHESTVol. 99Issue 4PreviewTo the Editor: Full-Text PDF